I have a dream: Integrative systemic transdiagnostic and transtheoretical approach in psychotherapy and mental health treatments

Abstract

Medicalization is a global trend in the societies of late capitalism and the biomedical model dominates in the mental health system. Despite its many shortcomings and harms and despite the categorical ICD and DSM diagnostic systems of mental disorders have been criticised from professional and scientific point of view, dimensional and transdiagnostic approaches to psychopathology and treatment are still relatively underdeveloped and neglected.

Over the last hundred years the differences between the biomedical and the biopsychosocial/contextual approach gave rise to and still drive ‘the great psychotherapy debate’. The biomedical approach emphasizes the dualism of body and mind, defines health as the absence of disease and places the origin of disease in the body. Diagnosis is based on a specific identification of this bodily cause and is the basis for planning and implementing a specific form of therapy. In contrast, the biopsychosocial/contextual approach emphasizes holism, and explains both health and illness as the result of an interplay of biopsychosocial factors in a multicausal manner. Diagnostics or assesment takes into account the individual in the historical, social, cultural, and economical context. Common factors theory, contextual model and CARE-Model of mental health treatments, that were developed in the tradition of biopsychosocial approach, promote the Dodo bird verdict, the diversity of therapists, emphasize the idiographic nature of therapeutic methods, client-centered perspective and individualised, personalized evidence-based practice.

Complexity science is already offering the transtheoretical frame as well as the technologies to realize the integrative systemic transdiagnostic and transtheoretical approach in psychotherapy and mental health treatments. If the starting point on the level of theory is the transtheoretical frame of synergetics as well as the mathematical formalism of the theory of complex dynamic systems, then the Synergetic Process Management (SPM) as a generic system enables the optimal and appropriate use of specific therapeutic methods and techniques according to the therapeutic process (e.g. resource-focused interview, idiographic system model, individualised process questionnaire for daily online monitoring, regular therapeutic sessions with feedback on basis of the current data-profile, and Synergetic Navigation System (SNS)), and can therefore contribute to the effectiveness of any psychotherapeutic approach or method. SNS is a highly flexible, generic internet-based system for data acquisition, time-series analysis, and visualisation of various questionnaires and coding systems. It enables real-time monitoring of the dynamic characteristics of biopsychosocial self-organizing processes.

The context of the great psychotherapeutic debate can also help us to understand the current public confrontations on the psychotherapy law in Slovenia, and to dream about psychotherapy as an independent profession and autonomous scientific discipline. It is a dream about more diversified, flexible, accountable, highly cost-effective, client- and context-tailored mental health treatments.